Orthopaedic Treatment of the Hip

The word "arthritis" literally means inflammation of a joint.

Arthritis of the hip joint, one of the most commonly affected joints, makes simple activities of daily living increasingly difficult.  Arthritis symptoms include difficulty with walking, arising from chairs, pain in the groin, buttock, thigh, or knee, and even difficulty with sleeping, dressing, or having sex.  Pain leads to limping. Eventually, weakness of the muscles around the hip develops.

The mainstay of treatment for hip arthritis is conservative, and includes the use of anti-inflammatory agents and physical therapy.  When these modalities are no longer effective, total hip replacement (THR) should be considered.

Hip Replacement Surgery

The development of THR is one of the most dramatic and successful events in orthopaedic history, and remains one of the most successful of all medical developments of the twentieth century.  Since its inception by Sir Doctor John Charnley in England in the 1960’s, millions have regained the ability to walk.

It is imperative that the surgeon and patient have a realistic understanding of the expected outcomes before deciding that hip replacement surgery is indicated.  The patient is first cleared for surgery by taking a battery of blood tests, x-rays, an electrocardiogram, and a physical examination.  If there is a specific medical problem then a specialist is asked to render an opinion concerning whether surgery is reasonable.  The patient’s blood is banked for use at the time of surgery if necessary, thereby protecting the patient from the possibility of blood-borne infection.  Drugs that can cause bleeding are stopped, including anti-inflammatory agents, aspirin products, or anti-coagulating agents such as Coumadin, Plavix, Fragmin, or Lovenox.

The patient enters the hospital the morning of surgery where the correct side to be operated on is verified. The anesthesiologist evaluates the patient and administers a sedative.  The surgery is generally done under spinal anesthesia except in the case of pre-existing back problems or bleeding disorders.

Once in the operating room, the old, damaged hip is removed.  The new parts, made of titanium, cobalt chromium, and other super metal alloys, as well as ceramic and/or high density polyethylene type plastics, are carefully fit for size and position.

Some are cemented in place while most are press-fit, a newer technique.

After about one hour of surgery the patient goes to the recovery room until the anesthetic wears off.  The patient is usually walking the next day and discharged either to a rehabilitation center or to home on the third day.  At this time the patient is able to walk with the assistance of a walker, crutches, or cane, go to the bathroom, and walk up and down stairs.  The patient will use an aid to walk for six to eight weeks.

Rare but possible complications include infection, blood clots, pneumonia, bleeding, nerve injury, dislocation or loosening of the prosthesis, wear of the prosthesis, or leg length abnormality.  Precautions to avoid these possible complications are taken in every case.

Ninety percent of hip replacements last around twenty years, and some have lasted over thirty.  When hip replacements fail it is usually because of wear or loosening, depending greatly on the weight and activity of the patient.  THR is one of the most successful and time-tested of all reconstructive surgical procedures.